Oregon Health Authority Has It Wrong

The fundamental errors which the Oregon Health Authority is trying to make policy can be traced to unproven or simply wrong assumptions around which the 2016 CDC Guidelines on prescription of opioids to chronic pain patients were based.

These assumptions were:

(1) The US is said to have a public health crisis in opioid addiction and overdose mortality caused by physicians over-prescribing medical opioids to their patients. Restrictions and enhanced oversight of medical opioid prescriptions are therefore deemed to be warranted to prevent further exposure of both patients and their untreated family members to such potential sources of addiction and death.

(2) Opioid pain relievers are said to be ineffective for chronic pain, when used for months or years.

(3) Safe and reliable alternatives to opioid therapy are said to exist and are declared preferable as substitutes for opioid therapy.

A fourth fundamental weakness of the Guidelines is expressed as a systematic omission.

(4) The Guidelines are silent with respect to the practical impact of significant variations in opioid metabolism between individual patients, due to genetic polymorphism in six key liver enzymes affecting 90% of all prescription medication metabolism.

However, published medical evidence deeply contradicts all four errors in the CDC paper.

(1) Data published by the CDC itself reveals that over-prescribing by doctors to their patients did not create our opioid crisis and is not sustaining it. The contribution of medically managed opioid pain relievers to opioid overdose mortality is so small that it gets lost in the noise.

(2) If opioids are ineffective then why are at least 1.6 million Medicare patients being maintained on doses exceeding the CDC guideline trip wire at 90 MMED — many of them for years?

(3) If safe and reliable alternatives to opioid analgesics exist, then why have none of them ever gone through large scale Phase II trials required for certification by FDA? And why have none of them ever been trialed as actual “replacements” rather than as adjuncts (additions) to usual therapy with analgesics?

(4) A well-established literature on opioid metabolism establishes a very wide range of minimum effective dose that greatly exceeds the CDC 90 MMED criterion. There is no one-size fits all patient or therapy plan.

The Oregon proposals basically lack medical and ethical support.

As discussed by Beth Darnall PhD, there are no published studies to establish any positive outcome from mandated tapering of legacy patients who are already stable with controlled pain. But there are multiple reasons for concern that patients coerced to taper may experience medical and psychological collapse.

3 thoughts on “Oregon Health Authority Has It Wrong”

Thanks for giving this article further visibility, Angelika. Quite remarkably the AMA is now on record opposing the misrepresentations of CDC Guidelines which have led to mass patient desertions. I am hopeful that they may soon make the next step and advocate for outright retraction of this fatally flawed document.

Thank you Richard – I was thrilled to hear about the AMA resolution condemning forced opioid tapers and lack of access to opioids, though I’m furious that they waited 2 1/2 years before saying anything at all about this clear infringement on medical practice.

When it was alternative therapies offering “medical treatment” back in the 80’s and 90’s, the AMA fought them tooth and nail, but now such treatments are government sanctioned. It would seem that medical restrictions by government would always be unethical.

EDSinfo is a growing collection of over 5,000 articles: excerpts of news, research, treatments, tips, and personal stories along with my own commentary.
Use the search box above or tag cloud below to find articles on your topic of interest.